Surgery of Petroclival Meningiomas: Report of 24 Cases

Neurosurgery ◽  
1989 ◽  
Vol 24 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Madjid Samii ◽  
Mario Ammirati ◽  
Ahmed Mahran ◽  
Walter Bini ◽  
Abholgasse Sepehrnia
Keyword(s):  
Cranial Nerve ◽  
Transverse Sinus ◽  
Surgical Approaches ◽  
Common Symptom ◽  
City Hospital ◽  
Petroclival Meningiomas ◽  
Number Of Patients ◽  
Microsurgical Techniques ◽  
Total Tumor Removal ◽  
The City

Abstract Twenty-four patients with petroclival meningiomas were operated upon at the neurosurgical clinic of the City Hospital of Hannover between 1978 and 1987. Seventeen were women and seven men; the mean age was 45 years. Symptoms were usually present for more than 2 years before the diagnosis was made. The most common symptom was disturbance of gait; the most common preoperative sign was cranial nerve deficit, mainly of the 7th and 8th nerves. Preoperative neuroradiological evaluation included computed tomography and four-vessel cerebral angiography. Fifteen patients (62%) had a tumor larger than 2.5 cm in its major diameter. The surgical approaches used were the retromastoid, pterional, subtemporal, and combined retromastoid-subtemporal. We developed a modification of the retromastoid-subtemporal approach with preservation of the transverse sinus and used this in the last 2 patients. There was no postoperative death; 11 patients (46%) suffered postoperative complications, mainly in the form of cranial nerve deficits, often reversible. “Total” tumor removal was achieved in 17 patients (71%). Twenty patients (83%) were independent at the time of discharge from the hospital. With accurate neuroradiological evaluation, careful choice of the surgical approach, and sound application of microsurgical techniques, petroclival meningiomas may be “totally” and safely resected in a significant number of patients.

scholarly journals Surgery of petroclival meningiomas. Recent surgical results and outcomes

2015 ◽  
Vol 22 (1) ◽  
pp. 27-37
Author(s):  
Mugurel Radoi ◽  
Florin Stefanescu ◽  
Ram Vakilnejad ◽  
Lidia Gheorghitescu ◽  
Daniela Rosu
Keyword(s):  
Tumor Resection ◽  
Cranial Nerves ◽  
Surgical Approaches ◽  
Subtotal Resection ◽  
Recent Experience ◽  
Surgical Results ◽  
Petroclival Meningiomas ◽  
Microsurgical Techniques ◽  
Postoperative Hydrocephalus ◽  
Loss Of Hearing

Abstract Petroclival meningiomas represent only 10% of all meningiomas located in the posterior fossa, but are some of the most formidable challenges in skull base surgery. We described our recent experience (2005-September2014) regarding the surgery of these tumors. We retrospectively analyzed surgical results and outcome in 11 cases of petroclival meningiomas. Most common symptoms in our series were headache and gait disturbance, while cranial nerves palsies represented the most common presenting signs. There were 8 females and 3 males, and the mean age was 52 years. Surgical approaches chosen for petroclival meningiomas in our series were retrosigmoid (9 patients) and subtemporal transtentorial (2 patients). We achieved total tumor resection in 5 cases (45%) and subtotal resection in 6 cases (55%). Overall outcome (total/subtotal resection) was good in 6 cases, fair in 3 cases and poor in one case. One postoperative death occurred due to hemorrhagic midbrain infarction (9%). Complications were usually related to cranial nerve deficits: loss of hearing (2 patients), paresis of trochlear nerve (1 patient), trigeminal nerve (3 patients) and facial nerve (1 patient). In 4 patients these cranial nerves deficits were transient. In one case, a patient developed postoperative hydrocephalus and needed shunt placement. Despite the fact that complications can be disastrous, we considered that an appropriate approach, combined with microsurgical techniques and a better understanding of the anatomy, greatly decrease the incidence and severity of complications and make feasible a total tumor resection.

Petroclival meningiomas: the risk of post-operative cranial nerve deficits among different surgical approaches—a systematic review and meta-analysis

2020 ◽  
Vol 162 (9) ◽  
pp. 2135-2143
Author(s):  
Davide Tiziano Di Carlo ◽  
Gabriele Capo ◽  
Arianna Fava ◽  
Federico Cagnazzo ◽  
Miguel Margil-Sànchez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cranial Nerve ◽  
Meta Analysis ◽  
Surgical Approaches ◽  
Petroclival Meningiomas

scholarly journals Surgical Treatment and Clinical Outcomes of Petroclival Meningiomas: A Single-Center Experience of 107 Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Baocheng Gao ◽  
Yongfa Zhang ◽  
Jiang Tan ◽  
Jinsong Ouyang ◽  
Bai Tai ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Clinical Outcomes ◽  
Cranial Nerve ◽  
Karnofsky Performance Status ◽  
Tumor Resection ◽  
Surgical Approaches ◽  
Cerebrospinal Fluid Leakage ◽  
Subtotal Resection ◽  
Petroclival Meningiomas ◽  
Cranial Nerve Dysfunction

ObjectiveThis study aimed to establish optimal surgical strategies via reviewing the clinical outcomes of various surgical approaches for the pertroclival meningiomas (PCMs).MethodsThis retrospective study enrolled 107 patients with PCMs at the authors’ institution from year 2010 to 2020. Patient demographics, the clinical characteristics, various operative approaches, major morbidity, post-operative cranial nerve deficits and tumor progression or recurrence were analyzed.ResultsThe subtemporal transtentorial approach (STA), the Kawase approach (KA), the retrosigmoid approach (RSA) and the anterior sigmoid approach (ASA), namely the posterior petrosal approach (PPA) were adopted for 17 cases, 22 cases, 31 cases and 34 cases respectively. Total or subtotal resection was achieved in 96 cases (89.7%). The incidence of new-onset and aggravated cranial nerve dysfunction were 13.1% (14/107) and 10.4% (15/144), respectively. Furthermore, 14 cases suffered from intracranial infection, 9 cases had cerebrospinal fluid leakage, and 3 cases sustained intracranial hematoma (1 case underwent second operation). The mean preoperative and postoperative Karnofsky Performance Status (KPS) score was 80 (range 60-100) and 78.6 (range 0-100), but this was not statistically significant (P>0.05). After a mean follow-up of 5.1 years (range 0.3- 10.6 years), tumor progression or recurrence was confirmed in 23 cases. Two cases died from postoperative complications.ConclusionsFor the treatment of PCMs, it is still a challenge to achieve total resection. With elaborate surgical plans and advanced microsurgical skills, most patients with PCMs can be rendered tumor resection with satisfactory extent and functional preservation, despite transient neurological deterioration during early postoperative periods.

What motivates Chinese physicians to provide online counseling services in Internet hospitals: online reputation or offline reputation? (Preprint)

2020 ◽  
Author(s):  
Ronghua Xu ◽  
Tingting Zhang ◽  
Qingpeng Zhang
Keyword(s):  
Regression Models ◽  
Counseling Services ◽  
Online Counseling ◽  
Consulting Services ◽  
Online Consultation ◽  
Number Of Patients ◽  
Professional Titles ◽  
Online Reputation ◽  
Chinese Physicians ◽  
The City

BACKGROUND Internet hospitals, or e-hospitals, as one kind of e-health platforms in China, provided novel channels through which physicians present their medical or health-care knowledge to patients and provide online counseling services. The sustainable development of Internet hospitals and e-health platforms relied on the participation of both the patients and the physicians, especially on the provision of health consultation services by the physicians. OBJECTIVE The objective of our study was to explore the factors motivating Chinese physicians to provide online health counseling services from the perspectives of their online reputation and offline reputation. METHODS We collected the data of 141,030 physicians from 6,173 offline hospitals and 350 cities on WeDoctor, an Internet hospital platform authorized by the China Health and Family Planning Committee. We selected the physicians’ online consultation volume, the total amount of counseling conversations from all channels of the platform, as the investigated dependent variable, reflecting the actual online counseling behaviors of the physicians in the platform. Based on the reputation theories and prior study, we incorporated patients’ feedback as the physicians’ online reputation (i.e. patients’ comments and their satisfaction scores), and incorporated the physicians’ offline professional status as the offline reputation (i.e. professional titles and the rankings of their offline working hospitals). We also delved the moderated effects of the city levels where the physicians lived offline and the number of patients who were watching the physicians online. Eight research hypotheses were proposed. Step-wise linear regression models were used to test our hypotheses. Durbin-Watson test and robustness tests were also conducted to ensure the fitness and reliability of our models. RESULTS As a result of the regression models, we found that, 1) physicians’ online reputation, including the number of comments written by the patients (beta=0.588, P<0.001), the satisfaction scores (beta=0.034, P<0.01), significantly and positively influence physicians’ online counseling behaviors; 2) Physicians’ offline reputation, including their professional titles (beta=-0.084, P<0.001) and the hospital rankings (beta=-0.163, P<0.001), significantly and negatively influence physicians’ online counseling behaviors; 3) the city levels where the physicians lived strengthen the negative effect between their offline hospital rankings and their online consulting services (beta=-0.177, P<0.001), indicating that physicians of higher offline reputation spend less time on online counseling, possibly due to the relative heavier offline workload; 4) the number of watching patients weakens the positive effect between patients’ comments and physicians’ online consulting services (beta=-0.216, P<0.001), indicating that the watching patients may switch the channels from online consultation to offline hospital visits after using the Internet hospitals. CONCLUSIONS This study contributed to the literature on physicians online counseling behaviors in Internet hospitals by verifying the contrasting effects of the online reputation and the offline reputation. It then contributed to the motivation theory by separating the online reputation from the offline reputation when the acting entities have constraints of limited time and effort. This study can also provide practical insights for the hospital managers to better arrange for the online counseling services and for the policy makers to consider the patients’ online feedback into the overall evaluation of the physicians’ reputation.

scholarly journals Primary Malignant Orbital Tumors

2021 ◽  
Vol 82 (01) ◽  
pp. 081-090
Author(s):  
Jacquelyn Laplant ◽  
Kimberly Cockerham
Keyword(s):  
Multimodal Therapy ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Imaging Features ◽  
Orbital Surgery ◽  
Diagnosis And Management ◽  
Microsurgical Techniques ◽  
Invasive Techniques ◽  
Traditional Approaches ◽  
Orbital Imaging

Abstract Objective Primary orbital malignancy is rare. Awareness of the characteristic clinical and imaging features is imperative for timely identification and management. Surgery remains an important diagnostic and treatment modality for primary orbital malignancy, but determining the optimal surgical approach can be challenging. The purpose of this article is to explore recent advances in the diagnosis, management, and surgical approaches for primary orbital malignancies. Design In this review, the clinical presentation, imaging features, and medical and surgical management of primary orbital malignancies with representative cases will be discussed. Setting Outpatient and inpatient hospital settings. Participants Patients with diagnosed primary orbital malignancies. Main Outcome Measures Descriptive outcomes. Results Advancements in orbital imaging, microsurgical techniques, and multimodal therapy have improved the diagnosis and management of primary orbital malignancies. Special considerations for biopsy or resection are made based on the tumor's location, characteristics, nearby orbital structures, and goals of surgery. Minimally invasive techniques are supplanting traditional approaches to orbital surgery with less morbidity. Conclusions Advances in imaging technologies and surgical techniques have facilitated the diagnosis and management of primary orbital malignancies. Evolution toward less invasive orbital surgery with focus on preservation and restoration of function is underway.

Surgical Management of Petroclival Meningiomas: Defining Resection Goals Based on Risk of Neurological Morbidity and Tumor Recurrence Rates in 137 Patients

Neurosurgery ◽  
2005 ◽  
Vol 56 (3) ◽  
pp. 546-559 ◽  
Author(s):  
Kenneth M. Little ◽  
Allan H. Friedman ◽  
John H. Sampson ◽  
Masahiko Wanibuchi ◽  
Takanori Fukushima
Keyword(s):  
Cranial Nerve ◽  
Tumor Recurrence ◽  
Critical Role ◽  
Recurrence Rates ◽  
Total Resection ◽  
Petroclival Region ◽  
Petroclival Meningiomas ◽  
Increased Risk ◽  
Neurological Morbidity

Abstract OBJECTIVE: Meningiomas arising from the petroclival region remain a challenging surgical problem. Because of the substantial risk of neurological morbidity, uniformly pursuing a gross total resection (GTR) to minimize tumor recurrence rates may not be justified. We sought to define optimal resection goals based on risk factors for postoperative neurological morbidity and tumor recurrence rates. METHODS: This series represents our experience with 137 meningiomas arising from the petroclival region resected between June 1993 and October 2002. There were 38 male and 99 female patients with a mean age of 53 years. RESULTS: GTR was achieved in 40% of patients, and near total resection (NTR) was achieved in 40% of patients. One operative death occurred. Twenty-six percent of patients experienced new postoperative cranial nerve deficits, paresis, or ataxia when assessed at a mean follow-up of 8.3 months. The risk of cranial nerve deficits increased with prior resection (P &lt; 0.001), preoperative cranial nerve deficit (P = 0.005), tumor adherence to neurovascular structures (P = 0.046), and fibrous tumor consistency (P = 0.005). The risk of paresis or ataxia increased with prior resection (P = 0.001) and tumor adherence (P = 0.045). Selective NTR rather than GTR in patients with adherent or fibrous tumors significantly reduced the rate of neurological deficits. Radiographic recurrence or progression occurred in 17.6% of patients at a mean follow-up of 29.8 months. Tumor recurrence rates after GTR and NTR did not differ significantly (P = 0.111). CONCLUSION: Intraoperatively defined tumor characteristics played a critical role in identifying the subset of patients with an increased risk of postoperative deficits. By selectively pursuing an NTR rather than a GTR, neurological morbidity was reduced significantly without significantly increasing the rate of tumor recurrence.

Evolution of Surgical Approaches in the Treatment of Petroclival Meningiomas: A Retrospective Review

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS202-ONS211 ◽  
Author(s):  
Nicholas C. Bambakidis ◽  
U. Kumar Kakarla ◽  
Louis J. Kim ◽  
Peter Nakaji ◽  
Randall W. Porter ◽  
...  
Keyword(s):  
Survival Rates ◽  
Progression Free Survival ◽  
Surgical Approaches ◽  
Single Institution ◽  
Short Term ◽  
Total Resection ◽  
Free Survival ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas

Abstract Objective: We examined the surgical approaches used at a single institution to treat petroclival meningioma and evaluated changes in method utilization over time. Methods: Craniotomies performed to treat petroclival meningioma between September of 1994 and July of 2005 were examined retrospectively. We reviewed 46 patients (mean follow-up, 3.6 yr). Techniques included combined petrosal or transcochlear approaches (15% of patients), retrosigmoid craniotomies with or without some degree of petrosectomy (59% of patients), orbitozygomatic craniotomies (7% of patients), and combined orbitozygomatic-retrosigmoid approaches (19% of patients). In 18 patients, the tumor extended supratentorially. Overall, the rate of gross total resection was 43%. Seven patients demonstrated progression over a mean of 5.9 years. No patients died. At 36 months, the progression-free survival rate for patients treated without petrosal approaches was 96%. Of 14 patients treated with stereotactic radiosurgery, none developed progression. Conclusion: Over the study period, a diminishing proportion of patients with petroclival meningioma were treated using petrosal approaches. Utilization of the orbitozygomatic and retrosigmoid approaches alone or in combination provided a viable alternative to petrosal approaches for treatment of petroclival meningioma. Regardless of approach, progression-free survival rates were excellent over short-term follow-up period.

Cranial Nerve and Hearing Function after Combined-Approach Surgery for Glomus Jugulare Tumors

1996 ◽  
Vol 105 (12) ◽  
pp. 949-954 ◽  
Author(s):  
Mislav Gjuric ◽  
Stephan Rüdiger Wolf ◽  
Malte Erik Wigand ◽  
Manfred Weidenbecher
Keyword(s):  
Tumor Growth ◽  
Cranial Nerve ◽  
Functional Results ◽  
Surgical Approaches ◽  
Tumor Removal ◽  
Transcervical Approach ◽  
Glomus Jugulare ◽  
Cranial Nerve Palsies ◽  
Ablative Surgery ◽  
The Individual

In this retrospective study, oncologic and functional results of 46 patients treated for glomus jugulare tumor are reported. The standard surgical approach was the combined transmastoid-transcervical approach, modified according to the individual tumor growth, and eventually combined with a transtemporal or a suboccipital approach. Complete tumor removal resulted in a cure rate of 90%. New-onset cranial nerve palsies developed in less than 22% of patients. In 54% of cases it was possible to retain middle ear function. From a total of 12 patients with incomplete tumor removal and postoperative irradiation, progressive tumor growth was noted in 4 patients, and was controlled by salvage irradiation or surgery. Radical tumor removal by ablative surgery can be modified by efforts to reduce mutilating resections. In their place, individually tailored and combined multidirectional surgical approaches may allow total tumor removal with lower morbidity.

Differentiation of Cocaine Toxicity: Role of the Toxicology Drug Screen

1988 ◽  
Vol 22 (7-8) ◽  
pp. 582-587 ◽  
Author(s):  
Christine M. Quandt ◽  
Roger W. Sommi ◽  
Travis Pipkin ◽  
M.H. McCallum
Keyword(s):  
Violent Behavior ◽  
Signs And Symptoms ◽  
Drug Analysis ◽  
Gas Liquid Chromatography ◽  
City Hospital ◽  
Street Address ◽  
Similar Area ◽  
Cocaine Toxicity ◽  
The City

Fifteen cases of presumed cocaine intoxication were evaluated in the emergency room (ER) at a city hospital over a four-day period. This series is unique in that many of these patients were from a similar area of the city, in some cases had the same street address, were regular abusers of cocaine, and presented to the ER with similar symptoms of tachycardia, dilated pupils, marked confusion, bizarre and sometimes violent behavior, psychosis, and hallucinations. Many of these symptoms were present several hours after drug use. Samples of a white powder presumed by the patients to be cocaine were obtained from two patients and analyzed by gas-liquid chromatography. Neither sample contained cocaine, but rather revealed atropine, benzocaine, and procaine. The signs and symptoms of cocaine, amphetamine, and atropine intoxication are reviewed and the problems of drug analysis and differential diagnosis of drug intoxication are discussed.

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